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YMCA of Central Kentucky
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Membership Change Form
Please indicate your home Y location
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Change Membership Type
Must be completed by
15 days prior to the draft date
Current Membership Type
New Membership Type
Add / Delete Household Members
Adult #2 plus any additional dependent children under the age of 24. Additional adults living in the same household over the age of 23 can be added for an additional $25 per month with proof of residency
Household Member
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Household Member 2
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Household Member 4
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Household Member 5
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New Account Type
Must be completed by
15 days prior to the draft date.
Please be sure to
Update Your Account
with the new billing method.
Account Type
Visa
MasterCard
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Change Draft Date
Prorated fees can be incurred.
1st
15th
Locker Rental
I would like to ...
Add Locker
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Locker Number
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Signature
Sign above
By submitting this form, I authorize the YMCA of Central Kentucky to make the changes listed above to my current membership. I authorize any changes in my bank draft amount that need to be made to coincide with the membership type I have chosen. If I choose to cancel my membership, I will notify the YMCA of Central Kentucky
at least 15 business days prior to my draft date.
Should my bank, for any reason, not honor my membership drafts, I understand that I am still responsible for that payment, plus any service charge applied by the YMCA.
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